Grandma’s aching knees and snapping fingers C1 LeeChuy, Katherine Lee, Sidney Abert Lerma, Daniel Joseph Legaspi, Roberto Jose Li, Henry Winston Li, Kingbherly Lichauco, Rafael Lim, Imee Loren Lim, Jason Morven Lim, John Harold Lim, Mary Lim, Phoebe Ruth Lim, Syndel Raina Lipana, Kirk Andrew Liu, Johanna Llamas, Camilla Alay
27
Embed
Grandma’s aching knees and snapping fingers C1 LeeChuy, Katherine Lee, Sidney Abert Lerma, Daniel Joseph Legaspi, Roberto Jose Li, Henry Winston Li, Kingbherly.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Grandma’s aching knees and snapping fingers
C1 LeeChuy, KatherineLee, Sidney Abert
Lerma, Daniel JosephLegaspi, Roberto Jose
Li, Henry WinstonLi, Kingbherly
Lichauco, RafaelLim, Imee Loren
Lim, Jason MorvenLim, John Harold
Lim, MaryLim, Phoebe RuthLim, Syndel Raina
Lipana, Kirk AndrewLiu, Johanna
Llamas, Camilla Alay
Chief Complaint
Chronic knee pain Pain and stiffness of thumb and middle finger of R hand
79 y/o F
History of Present Illness
Past Medical History
Physical Examination
• Normal vital signs; BMI 28
Musculoskeletal Exam
• Crepitus on both knees without effusion• 1st and 3rd fingers of R hand would snap on flexion
and required assistance due to pain on attempted extension
Physical ExaminationStooped posture
Bilateral genu varum deformity
Non-tender bony nodes on PIP and DIP
Salient Features• 79 y/o female• Years of painful knees, pronounced when walking• Crepitus on both knees without effusion• Bilateral genu varum• Pain and stiffness of thumb and middle finger of R
hand• would snap on flexion and require assistance on
extension• Non-tender bony nodules on PIP and DIP• Diagnosed with osteoporosis, received 2 yearly
infusion of zoledronic acid• Stooped posture• Hypertension controlled on daily amlodipine
Musculoskeletal signs and symptoms in the Patient
• Painful knees, more pronounced on walking; Non-tender bony nodules on PIP and DIP; Crepitus on both knees without effusion; bilateral genu varum
• Pain and stiffness of thumb and middle finger of R hand; would snap on flexion and require assistance on extension
• Stooped posture; previous diagnosis of osteoporosis with prescribed medication
Musculoskeletal conditions in the Patient
OsteoarthritisPainful knees, more pronounced on walking; Non-tender
bony nodules on PIP and DIP; Crepitus on both knees without effusion; bilateral genu varum
“Trigger Finger/ Digit”Pain and stiffness of thumb and middle finger of R hand;
would snap on flexion and require assistance on extension
OsteoporosisStooped posture
Osteoarthritis
Patient Osteoarthritis79 years old female leading cause of disability in the
elderlyBMI = 28 ObesityPainful knees; Crepitus on both knees without effusion
affected joints include the cervical and lumbosacral spine, hip, knee.
Painful knee on walking Joint pain from OA is activity-related
Non-tender bony nodules on PIP and DIP
Presence of Heberden’s nodes in DIP and Bouchard’s nodes in PIP
Management for OA
Non-pharmacologic Management(1) avoiding activities that overload the joint, as evidenced by their causing pain(2) improving the strength and conditioning of muscles that bridge the joint, so as to optimize their function(3) unloading the joint, either by redistributing load within the joint with a brace or a splint or by unloading the joint during weight bearing with a cane or a crutch.
Management for OA
Exercise lessens pain and improves physical functionconsist of aerobic and/or resistance training (strengthens muscles across the joints)
Management for OA
Correction of Malalignment(Genu Varus/Valgus)• Leg brace• Surgery
Management for OA
“Trigger-finger/digit”Patient Trigger-finger
•Pain and stiffness of thumb and middle finger of R hand•would snap on flexion and require assistance on extension
•common disorder of later adulthood characterized by catching, snapping or locking of the involved finger flexor tendon, associated with dysfunction and pain
• Local steroid injection– Cortisone, prednisolone, dexamethasone, and
triamcinolone.– A mixture of steroid, 1% lidocaine, and 0.5%
bupivacaine is used, in a ratio of 2:1:1, respectively
– After injection, the patient is encouraged to move the digit.
– A follow-up appointment is made for 3-4 weeks after the treatment
Management for “Trigger-finger/digit”
• Splinting– For those patients who decline injection– MCP joint is splinted in approximately 15° of
flexion.
Osteoporosis
Patient Osteoporosis
79 y/o Advanced age
Female Female sex
Estrogen deficiency
Low calcium intake
Alcohol and cigarette consumption
Management for Osteoporosis
To maintain bone health: • Make sure there is enough calcium in your
diet• Get adequate vitamin D intake, which is
important for calcium absorption and to maintain muscle strength
• Get regular exercise, especially weight-bearing exercise.
Management for Osteoporosis
• Bisphophonates – alendronate, residronate, etidronate– Patient was given zoledronic acid
• Calcitonin– Calcitonin works by directly inhibiting osteoclast
activity via the calcitonin receptor. – Calcitonin directly induces inhibition of
osteoclastic bone resorption by affecting actin cytoskeleton which is needed for the osteoclastic activity.
Management for Osteoporosis
• Selective Estrogen Receptor Modulators (SERMs)– are a class of medications that act on the estrogen
receptors throughout the body in a selective manner
– Raloxifene (60 mg/d) - act on the bone by slowing bone resorption by the osteoclasts
What is the mechanism of action of NSAIDs?
NSAIDs
• Most NSAIDs act as nonselective inhibitors of the enzyme cyclooxygenase(COX), inhibiting both the cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) isoenzymes.
• COX catalyzes the formation of prostaglandins and thromboxane from arachidonic acid
• Prostaglandins act as messenger molecules in the process of inflammation.